Healthcare Provider Details

I. General information

NPI: 1275032203
Provider Name (Legal Business Name): WYLIE ER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HIGHWAY 78
WYLIE TX
75098-3947
US

IV. Provider business mailing address

6030 S RICE AVE STE C
HOUSTON TX
77081-2944
US

V. Phone/Fax

Practice location:
  • Phone: 713-660-0555
  • Fax:
Mailing address:
  • Phone: 713-660-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOM VO
Title or Position: MANAGER
Credential:
Phone: 713-660-0557